Equity Funding Request Form :: Office of Diversity, Equity, and Inclusion

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Date

Who is the main contact for the request?*

First Last

Please Identify Your Classification

Administrator/Exempt Staff
Classified Staff
Faculty

Phone*

Department/Program*

Bellevue College Email*

Enter Email Confirm Email

What date is the proposed event?*

Proposal Title*

Target Audience (check all that applies)*

Students
Faculty
Classified Staff
Administrators

Anticipated Number of Attendees*

Proposal (Please Include the intended impact of program, event, or initiative).*

Please identify which of the goals will be addressed within your hour(s) of service.

Focus on the student’s experience to develop and promote support services/programs while growing, diversifying, and shaping our student body.
Develop an educational community of anti-bias learning that adapts its goals and principles to the specific needs of learners.
Create positive learning environments that are safe, supportive, and engaging.
Partner with (local, regional, state, national, global) communities to enhance the social, economic, and cultural well-being of our campus

Will This Effort be Sustainable?*

Yes
No

Is This Effort Replicable

Yes
No

What activities/strategies will you use to achieve the advancement of cultural engagement and learning?*

Indicate which core value(s) is/are connected to your proposal.*

Please identify which of the core values will be addressed within your hour(s) of service.

Focus on the student’s experience to develop and promote support services/programs while growing, diversifying, and shaping our student body.
Develop an educational community of anti-bias learning that adapts its goals and principles to the specific needs of learners.
Create positive learning environments that are safe, supportive, and engaging.
Partner with (local, regional, state, national, global) communities to enhance the social, economic, and cultural well-being of our campus.

How do the core values relate to your request?*

How will you know if learning and/or behavioral change took place from participaiting in your event?*

How will you measure the success of your event?

Requested amount?

All funding requests are expected to provide a service to the college that is accessible to everyone. This service may be covered within the event itself, if held on Bellevue College grounds or the surrounding Bellevue community. Those individuals requesting professional development funds will have to provide explanation of a workshop/training/community service/office support/etc. that will account for the service to the college.

Does your request exceed $3,000?*

No
Yes

If a request exceeds $3,000, it may be reviewed in collaboration with the Equity Education Advisory Committee (EEAC). Please permit three – four weeks of advance notice so that all applications may receive proper review. The Office of Diversity, Equity, and Inclusion will be responsible for responding to the requests under $3,000 and will evaluate requests using the inclusive content for funding guidelines.

Three – Four Week Planning Required*

Yes, I confirm I’m planning beyond six weeks to allow sufficient time for a committee to form and decide on this proposal.

Who is sponsoring and/or collaborating with the event?*

Write a contact’s name for each sponsor or collaborator.

Supervisor Approval*

If the planning or proposal is within employment hours, please check to confirm you and/or group members have had supervisor approval to participate in facilitating this institutional change. You must have approval prior to submitting this request. (The Office of Diversity, Equity, and Inclusion may only assist with financial support. The office does not have the authority to approve the allocation of employee time to these activities.)

Yes, I confirm I have supervisor approval to attend.

Equity Funding Request Form

Equity Fund Form

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